The Arizona CERT (AzCERT) is a consortium of the University of Arizona (UA) and the Critical Path Institute (C-Path), a non-profit organization in Tucson, AZ. The AzCERT has six years of experience in the prevention of adverse drug reactions (ADDRs) associated with drug-drug interactions (DDIs), especially those that harm women. This application expands on this theme using a systems approach to examine the underlying human and systems factors responsible for the co-prescription, co-dispensing and co-administration of drug combinations that have the potential to interact (PDDIs) and cause ADDRs. Our specific aims are to 1) improve patient safety by reducing PDDIs and 2) improve health outcomes by reducing ADDRs. Research will examine the effectiveness of provider-targeted and patient-targeted interventions on PDDIs and ADDRs. The AzCERT will continue its very productive collaborations with the Veterans Administration Healthcare System to evaluate the effectiveness of alerts to physicians for preventing PDDIs and ADDRs. We will also evaluate the effectiveness of a "near real time" fax alert program that includes Medicare Part D prescribers for prevention of PDDIs and ADDRs in medication management call centers (UA and Caremark). We will evaluate innovative PDDI educational interventions that take place in community settings, including clinical laboratories and community health centers (CHC) and capture the "teachable moment" when patients are waiting to have blood drawn for monitoring warfarin, digoxin and other drug therapies. AzCERT will develop and evaluate innovative "train-the-trainer" programs as part of the inter-professional curriculum in the UA colleges of nursing, medicine and pharmacy. The AzCERT has well-established international (web-based), national, regional and community educational and dissemination programs that are based on research conducted by AzCERT and others. The internationally recognized website, QTdrugs.org (360,000 visits in 2005) will be expanded and made more interactive through collaborations with the FDA, Lincoln Technologies and DrugLogic. Together with the FDA, AMA and the American College of Clinical Pharmacology, we will inform providers and patients about DDI and new gene-based dosing for warfarin through multiple approaches including a new website, www.warfarin-ddi.org. In this application, we will greatly expand our dissemination efforts to include public service announcements featuring former U.S. Surgeon General Richard Carmona. All of this work will focus on evidence-based, culturally sensitive interventions, thorough evaluation and dissemination of information that is relevant to patients, especially the Hispanic, Native American and under-served urban and rural populations in AZ. Dissemination will be facilitated by collaborative relationships with the AZ Association of CHCs, clinical laboratories, the Area Health Education Centers (AHEC), UA College of Agriculture Cooperative Extension and Cox Cable. The AzCERT will leverage the federal funding for this grant through partnerships that extend our reach and our ability to improve health outcomes for patients.